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Organization
STAT MED P.A.
Active
Organization
STAT MED P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA L EVANS III (PROVIDER ENROLLMENT REP)
(270) 744-9600
Entity
Organization
Contact information
Practice address
902B N AUSTIN AVE, GEORGETOWN, TX 78626-4333
(521) 930-7828
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-8642
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0029NV
BCBS
TX
Enumeration date
08/01/2006
Last updated
02/26/2008
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